Mealtime Partners, Inc.

Cerebral Palsy (CP) occurs in 2.4 of every thousand births in the United States. It is the most commonly occurring neurodevelopmental disability and impacts individuals over a vast range of severity. Over the past 20 years the rate of occurrence of CP has not significantly changed, even though prenatal care has notably improved as has neonatal intensive care for infants.

Children with mild CP who are able to walk independently without difficulty, are less likely to experience eating difficulties or poor growth; those with significant difficulties with mobility are more likely to have eating difficulties and poor growth.

The association between problems with eating, swallowing, and general oral motor difficulties and CP, has been well documented for many years. It is estimated that 30% to 40% of children diagnosed with CP experience feeding difficulties. It is also understood that difficulties with eating can limit the amount of food that is consumed at each meal and makes adequate food consumption challenging. Mealtimes can be protracted, and parents, or caregivers, may spend many hours each day in an attempt to feed their child enough calories and nutrition. For some children the problem is exacerbated by their frequent vomiting. Food that has been consumed is consequently lost. Along with these problems, the lack of easy communication can intensify mealtime difficulties. A child may be unable to express their likes or dislikes of the food being offered, that they feel unwell; that they hurt; their feeling of being full, etc. All of these factors can create a stressful mealtime environment.

Until relatively recently, the growth charts that were generally used by pediatricians to evaluate children’s growth were those published by the Centers for Disease Control and Prevention (CDC). Thus even though these charts were designed to be used for children without disabilities, they were also used for evaluating growth in children who have CP. In most cases the child with CP who had significant motor dysfunction, appeared on the lowest percentile of these growth charts (if they registered on the chart at all). However, more recently, research has identified that children who have CP have bodies and energy expenditure that is different from the average child and, therefore, the use of the same growth charts is inappropriate.

In 2007, Day¹, et al, published the results of a study they conducted that assessed height and weight from growth records of 24,920 children with a diagnosis of CP who were being treated by California Department of Developmental Services. The records were broken down by age, and gender. Additionally, they were divided into 5 categories based on functional abilities: 1. Walks well alone for 6 meters; 2. Walks unsteadily or with support for 3 meters; 3. Crawls, creeps or scoots, but does not walk; 4. Does not walk, crawl, creep, scoot or self feed; 5. Does not walk, crawl, creep, scoot or self feed, but is fed by a gastrostomy tube.

The charts that resulted were compared with the CDC weight and height charts. It was found that children with CP in group 1 had a height and weight that was similar to those of children assessed by the CDC chart who had no known disabilities. However, groups 2 through 5 differed significantly and lagged behind the general population. Those in group 5 (those who had a feeding tube) exhibited more weight and height gain than those who had severe CP and were fed by mouth.

The "Growth patterns in a population of children and adolescents with cerebral palsy" study (referred to above) indicates a clear correlation between the severity of motor dysfunction and feeding difficulties in children with CP. The inability to intake enough food, if left untreated, leads to undernutrition and malnutrition that, in turn, leads to smallness of stature, low body fat, and reduced muscle mass. Additionally, wasting (i.e., low weight for height), which is directly related to low food intake, occurs in not only children with CP who have severe movement limits, but also occurs in individuals who have mild to moderate mobility limits and CP.

Even though it is desirable for a child to develop the skills to self-feed, many children with severe levels of CP are unable to eat independently. For some, the effort required to undertake the task is so great that it can have a detrimental impact upon their chewing, swallowing and ability to keep food in their mouth (lip-closure). Also, because they exert so much effort controlling their body, both in stabilizing their trunk and head, and in managing to lift food to their mouth, that they exert more energy than they are able to consume. If this was their only means of eating they would rapidly become undernourished. Therefore children with this level of mobility difficulties should typically be fed. This does not mean that they should not be encouraged to self-feed. It simply means that the majority of their calories should be provided to them by a feeding partner while they enjoy the experience of practicing eating but are not dependent upon themselves for all of the calories that they need to consume.

It is important that all children with CP consume a nutritious diet and consume the appropriate volume of food to maintain a healthy body. One of the consequences of undernourishment is muscle weakness. Muscle strength is not only important for mobility and skeletal control but also to maintain respiratory health. If muscles are weak, coughing is also weakened and the lungs are at a greater risk of infection.

There are many sources of support for children who have oral motor difficulties due to CP. Talk to your doctor, speech pathologist, or occupational therapist to find resources in your area. Additionally, parent support groups are a wonderful resource.

When looking at the future for children who have cerebral palsy, it is important to provide them with as much independence as possible. For those who are able to drink from a straw you might consider one of Mealtime Partners hands-free drinking systems. For those who are able to eat comfortably from a spoon, a Mealtime Partner Dining System probably would be of significant value for improving their health and quality of life. If you would like to discuss these items with our staff please call 800-996-8607 or email us at questions@mealtimepartners.com. We would be pleased to help.

In the last few years insulated tumblers have become very popular because they are able to keep drinks either hot or cold for an extended time. Many of our customers have expressed a desire to have an insulated tumbler that can fit into their existing hands free drink holder. They also wanted a built-in flex tube that can position the drinking straw. As a result of this input Mealtime Partners has recently made an insulated tumbler available that can fit into the cup holder used for Front Mounted Drinking Systems and also the cup holder that is part of the Drink-Partner Drinking System (MtP Part No. 6040).

The Insulated Tumbler is a stainless steel container that holds 16-ounces of hot or cold liquid. It keeps liquids hot or cold for several hours. Importantly, the tumbler has a screw-on stainless steel lid that has flex tubing integrated into it. Many of the very popular insulated tumblers have plastic lids that are not strong enough to allow a flex tube to be installed in them. Without flex tube, the drinking tube cannot be positioned for easy access by the user.

The flex tube that is part of the lid contains the drinking tube from which the user drinks. Just like the Drink-Partner, once positioned, the flex tube will hold the drinking tube in position, until it is further adjusted.